GUEST POST: Happy Birthday Affordable Care Act, you are good for children

Wednesday, March 30, 2011

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Dr. Victoria Chen (pictured here) writes: Earlier this month on March 23, 2011 was the 1-year anniversary of the Affordable Care Act (ACA). Just as when it passed, the spotlight has shone on the controversial parts of the bill as reasons to repeal or defund the bill entirely. What gets less attention in this political battle is the good that has been done, especially for children.

Before the ACA, some oncologynurses in our hospital raised a pool of money for a child with cancer because she had lost her health care coverage. This does not need to happen now that the ACA has made it illegal for insurance plans to impose lifetime dollar limits for essential health benefits, bans pre-existing conditions for children up to age 19, and bans all private insurance companies from rescinding coverage, except for fraud.

ACA not only expands coverage for children, but it will reduce long-term health care costs. There has been extensive research that an increase in the number of primary care doctors in a given area has a direct effect in decreasing the number of ER visits and hospitalizations. With increased access to primary care, people are healthier and health care costs are lowered. This led to legislation in the ACA to ensure that children are insured, children’s basic health care needs are covered by their insurance (through guaranteed coverage of Bright Futures services), and that there are pediatricians to see them through increases in the primary care workforce (via the expansion of the National Health Service Corps and increased funding for residency programs that train primary care physicians). These changes would make it less likely that I would care for an asthmatic child in the emergency room or the intensive care unit because they could not get appropriate asthma care from a primary care pediatrician.

I received my pediatric residency training here at Children's National in DC, at a program that focuses on understanding children’s environment (school, home, socioeconomic status) as a vital component of understanding the health problems they have. This community health track program is rather competitive, in the past only taking four residents per year. Many residents over the years have been turned away from this unique learning opportunity. You may think the field of medicine would look different if there were more residents trained in this fashion. Well, now there will be. This year, we were able to accept 8 residents instead of 4 into this track because of funding from the ACA.

The ACA is not perfect, but it is an improvement over our previous system -- especially for children. To completely repeal or defund it is not a wise option, since we cannot afford to undo the progress we have made. Instead, we should all mark the 1-year anniversary of the ACA – love it or hate it – by learning more about it (the 9 minute video and summary articles can be found at the non-partisan Kaiser Family Foundation website). Only then can we have a productive discussion of what we can change without hurting our most vulnerable citizens.